Obamacare finally clears the tower

The administration likely won't meet its goal of 7 million sign-ups, but 6 million is possible. | AP Photo

Not all of the numbers are going to stick

The administration’s numbers still count everyone who has “selected” a plan – meaning they might have paid their first premium, or they might not. And officially, they’re only enrolled if they’ve paid up.

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There aren’t any solid numbers yet on how many of these Obamacare customers are actually enrolled, and administration official say they don’t have that data yet. But from what insurance company executives have said publicly, it appears that most have paid for their coverage – but not all have.

That means the real Obamacare enrollment numbers are probably a bit lower than what the administration reported Wednesday. Not low enough to be disastrous, but low enough that Obamacare watchers should still be skeptical of the official numbers.

Aetna officials, for example, have said that only about 70 percent of their customers have paid for their Obamacare coverage. WellPoint chief financial officer Wayne DeVeyd recently said that while most of its customers have paid up, “we’re not at what I’ll call a vast majority yet,” according to Kaiser Health News.

If you reduce the signup numbers by 30 percent – assuming Aetna’s payment rates are roughly in line with other insurers – that would leave about 2.3 million people who can safely be counted as enrolled.

But there’s nothing scientific about that number, either — and one way or another, independent analysts still believe 6 million is within reach by the time the enrollment season is over.

The age mix is still skewing older

With a meltdown seemingly avoided, the next big test, most health care experts agree, is whether there will be the right mix of healthy and sick people — and right now, there are still a lot of older adults in the mix.

The administration tried hard to play up a slight increase in the percentage of young adults. In January, 27 percent of the signups came from people age 18 to 34 — up from 24 percent in the period between October and December.

“The covered population is getting younger,” Health and Human Services Secretary Kathleen Sebelius said on a conference call with reporters.

Maybe, but that still leaves 68 percent who were between ages 35 and 64. And of the total enrollment since signups began, 31 percent are in the oldest category, between 55 and 64.

And according to the Kaiser Family Foundation, young adults are 40 percent of the market — so they’re still underrepresented, even with the latest growth.

Gruber, however, said the age mix “got somewhat better” and is in line with the trends in Massachusetts, where most young adults waited until the end to sign up in the first year of its health reform program.

And on the conference call, Julie Bataille, a spokeswoman for the Centers for Medicare and Medicaid Services, said Massachusetts ended up with about 34 percent young adults in its first year — enough to be financially stable.

“We believe that we have work to do,” but “by the end of the open enrollment period we will have millions of Americans successfully enrolled,” Bataille said.

What do the insurers think?

The bottom line, health care experts say, is whether the new numbers will give health insurers enough confidence to stay in the game — and not jack up their premiums for next year because they didn’t get as many customers as they wanted, or the right mix of healthy and sick people.

When they set their rates for this year, health insurers basically had to take their best guesses at how many customers they’d get and what the mix would be. If they guessed right, their Obamacare prices for next year should be pretty close to what they’re charging this year. If not, next year’s rates will be a lot higher.

“What really matters is this complicated model of what the insurers expected and whether it fits their expectations, and there’s no point in trying to guess that until the rates come out,” said Gruber.

So a lot will depend on what happens with the young adults — and whether the Obama administration and its allies can goose those numbers right before enrollment ends March 31.

The current mix “supports my hypothesis that the older, sicker enrollees will sign up first, and the younger, healthier people will enroll later,” said Pearson. “So, the more enrollment occurs in the next two months the better the risk pool should be. Assuming that trend continues, the current age mix … is not cause for alarm.”